PMID- 31399946
OWN - NLM
STAT- MEDLINE
DCOM- 20210528
LR  - 20210528
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 34
IP  - 6
DP  - 2020 Jun
TI  - Evaluation of anterior versus posterior component separation for hernia repair in 
      a cadaveric model.
PG  - 2682-2689
LID - 10.1007/s00464-019-07046-9 [doi]
AB  - BACKGROUND: Component separation remains an integral step during ventral hernia 
      repair. Although a multitude of techniques are described, anterior component 
      separation (ACS) via external oblique release (EOR) and posterior component 
      separation (PCS) via transversus abdominis muscle release (TAR) are commonly 
      utilized. The extent of myofascial medialization after ACS or PCS has not been 
      well elucidated. We conducted a comparative analysis of ACS versus PCS in an 
      established cadaveric model. METHODS: Fifteen cadavers underwent both ACS via EOR 
      and PCS via TAR. Following midline laparotomy (MLL), baseline myofascial 
      elasticity was measured. Steps for ACS included creation of subcutaneous flaps 
      (SQF), external oblique release (EOR), and retrorectus dissection (RRD). For PCS, 
      steps included retrorectus dissection (RRD), transversus abdominis muscle 
      division (TAD), and retromuscular dissection (RMD). Maximal advancement of 
      anterior rectus fascia (ARF) was measured following application of tension to the 
      fascia as a whole, and separately at upper, middle, and lower segments. 
      Statistical analysis was performed with Mann-Whitney U test. Values are 
      represented as average myofascial medialization in centimeters. RESULTS: 
      Following MLL an average of 5.0 +/- 0.9 cm (range 3.4-6.0 cm) of baseline 
      medialization was obtained. Complete ACS provided 8.8 +/- 1.2 cm (range 
      6.3-10.7 cm) of ARF advancement compared to 10.2 +/- 1.7 cm (range 7.6-12.7 cm) 
      with PCS, p = 0.046. In the upper and mid-abdomen, we noted increased ARF 
      advancement with PCS versus ACS (8.1 +/- 1.4 cm vs. 6.7 +/- 1.2 cm and 11.4 +/- 1.5 vs. 
      9.6 +/- 1.4 cm, respectively, p = 0.01). Similar levels of ARF advancement were 
      observed in the lower abdomen, 9.1 +/- 1.7 cm versus 8.7 +/- 1.8 cm, p = 0.535. 
      CONCLUSIONS: Component separation via both anterior and posterior approaches 
      provide substantial myofascial advancement. In our model, we noted statistically 
      greater anterior fascial medialization after PCS versus ACS as a whole, and 
      especially in the upper and mid-abdomen. We advocate PCS as a reliable and 
      possibly superior alternative for linea alba restoration for reconstructive 
      repairs, especially for large defects in the upper and mid-abdomen.
FAU - Majumder, Arnab
AU  - Majumder A
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, 
      OH, USA.
FAU - Martin-Del-Campo, Luis A
AU  - Martin-Del-Campo LA
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, 
      OH, USA.
FAU - Miller, Heidi J
AU  - Miller HJ
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, 
      OH, USA.
FAU - Podolsky, Dina
AU  - Podolsky D
AD  - Columbia Hernia Center, Department of Surgery, Columbia University Medical 
      Center, Columbia University, 161 Fort Washington Ave, New York, NY, 10032, USA.
FAU - Soltanian, Hooman
AU  - Soltanian H
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, 
      OH, USA.
FAU - Novitsky, Yuri W
AU  - Novitsky YW
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, 
      OH, USA. yn2339@cumc.columbia.edu.
AD  - Columbia Hernia Center, Department of Surgery, Columbia University Medical 
      Center, Columbia University, 161 Fort Washington Ave, New York, NY, 10032, USA. 
      yn2339@cumc.columbia.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190809
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Cadaver
MH  - Female
MH  - Hernia, Ventral/*surgery
MH  - Herniorrhaphy/*methods
MH  - Humans
MH  - Male
OTO - NOTNLM
OT  - Component separation
OT  - External oblique release
OT  - Myofascial advancement
OT  - Transversus abdominis release
OT  - Ventral hernia repair
EDAT- 2019/08/11 06:00
MHDA- 2021/05/29 06:00
CRDT- 2019/08/11 06:00
PHST- 2019/04/14 00:00 [received]
PHST- 2019/07/24 00:00 [accepted]
PHST- 2019/08/11 06:00 [pubmed]
PHST- 2021/05/29 06:00 [medline]
PHST- 2019/08/11 06:00 [entrez]
AID - 10.1007/s00464-019-07046-9 [pii]
AID - 10.1007/s00464-019-07046-9 [doi]
PST - ppublish
SO  - Surg Endosc. 2020 Jun;34(6):2682-2689. doi: 10.1007/s00464-019-07046-9. Epub 2019 
      Aug 9.